Dermatology

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A 5-year-old boy was brought to the emergency department by his parents because of a rash that covered his entire body. The rash had started 2 days earlier, initially on the boy’s face, abdomen, and legs and had spread to his back, buttocks, and hands. There was a 1-day history of tactile fever when the child was sent home from school. He had no sick contacts and his immunizations were up-to-date. He had no significant medical history.

This distribution of an inflammatory disorder in a very young child almost always indicates atopic dermatitis. The family history of asthma suggests the atopic diathesis.

The history and lesional morphology are virtually pathognomonic for a dental sinus. Radiographic examination revealed an apical dental abscess that communicated with the skin via a sinus tract.

The mother of a 13-year-old boy arrives in your office with her son for an urgent visit. She was diagnosed with a malignant melanoma last week, and her mother died from disseminated melanoma 2 years ago.

Scabies

Any itchy penile rash should immediately suggest scabies. The latter also typically involves the hands, especially the interdigital webspaces and the volar aspect of the wrist.